| NPI | 1326543711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 60056) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY Tp319) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2026-09-21 |